The association of fruit and vegetable specific antioxidants with bone mineral density and fracture in the Framingham Osteoporosis Study

Background. Studies have consistently shown that higher fruit and vegetable intake has positive effects on bone health. Dietary antioxidants present in fruit and vegetables such, as vitamin C and carotenoids may play a role in bone health.;Objectives. (1) To examine the association of total and individual carotenoid (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein plus zeaxanthin and lycopene) intake with baseline bone mineral density (BMD) and 4-y change in BMD. (2) To examine the association of total carotenoid and individual carotenoid intake with hip fracture and non-vertebral osteoporotic fracture. (3) To examine the association of vitamin C (total, dietary and supplemental) intake with baseline BMD and 4-y change in BMD. (4) To study the association between vitamin C and hip fracture as well as non-vertebral fracture in elderly men and women in the Framingham Osteoporosis Study.;Study design. The Framingham Heart Study began in 1948 to examine risk factors for heart disease. In 1988--89, out of the surviving subjects from the original cohort, 1164 subjects (mean age: 75 y) participated in the Framingham Osteoporosis Study. Number of subjects may vary for individual objectives depending on exclusion criteria used.;Results. Longitudinally, all the carotenoids except beta-cryptoxanthin and alpha-carotene showed protective associations against 4-y loss in trochanter BMD in men and with lycopene intake at lumbar spine in women. No significant associations were observed at other bone sites among men or women.;In the combined sample of men and women, total carotenoid and lycopene intake had a protective effect on the risk of hip fracture and non-vertebral fracture. beta-carotene may also be protective for hip fracture. No significant associations were observed for alpha-carotene, beta-cryptoxanthin or lutein plus zeaxanthin.;Longitudinally, marginal protective associations were observed for total vitamin C and 4-y change in femoral neck and trochanter BMD in men with low calcium or vitamin E intake. Protective association was observed for dietary vitamin C intake at multiple bone sites in men. No associations were observed among women. No associations were observed for supplemental vitamin C intake among men or women.;In the combined sample of men and women, total and supplemental vitamin C intakes were protective for hip fracture and non-vertebral fracture. A similar protective trend was observed for dietary vitamin C but the associations did not reach significance.;Conclusions. Together, the findings from these studies, suggest a possible protective effect of carotenoid intake on trochanter BMD in men and on lumbar spine BMD in women. Additionally, we observed a protective effect of carotenoid intake on the risk of hip fracture and non-vertebral fracture among men and women. Dietary vitamin C intake appeared to be protective against 4-y losses in BMD among men while total vitamin C intake appeared to be protective only among men with low calcium or vitamin E intakes. We also observed a protective effect of total and supplemental vitamin C intake against fracture in this population of elderly Caucasian men and women. It is therefore possible that carotenoids and vitamin C explain part of the previously observed protective effects of fruit and vegetable intake on BMD and fracture.